THE WELCH COMPANY
440 Davis Court #1602
San Francisco, CA 94111-2496
415 781 5700
rodwelch@pacbell.net


S U M M A R Y


DIARY: April 7, 2009 10:09 AM Tuesday; Rod Welch

Called Arlette to ask Doctor Johnson about examination for Millie
requested by Doctor Rugo and Doctor Hsu at UCSF.

1...Summary/Objective


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CONTACTS 

SUBJECTS
White Blood Cell Condition Blood Test Shows Too Low Doctor Johnson A

0403 -
0403 -    ..
0404 - Summary/Objective
0405 -
040501 - Follow up ref SDS 49 0000. ref SDS 42 0000.
040502 -
040503 -
040504 -
040505 -
040506 -
040508 -  ..
0406 -
0407 -
0408 - Progress
0409 -
040901 - On 090330 1200 Doctor Hsu made a quick examination, ref SDS 49 9A66
040902 - and indicated Millie's condition looks as expected for the amount of
040903 - radiation received during treatments that started at UCSF on 090219
040904 - and completed on 090317, as called out in the UCSF treatment plan
040905 - received in the record on 090226. ref SDS 35 D452
040907 -  ..
040908 - On 090331 Millie went hiking at Lafayette Reservoir.  She did 1 lap in
040909 - a good time, faster than in recent weeks, which have been infrequent.
040910 - Millie's breathing seemed under stress for the entire hike, after
040911 - getting up the first hill.  Normally, she recovers well, but on 090331
040912 - breathing was heavy the rest of the way, about 2 miles.  That evening,
040913 - Millie experienced fever with elevated temperature 99.4. ref SDS 50
040914 - E54L  A few days later on 090402, Millie again had elevated
040915 - temperature and shortness of breath with cough that prevented sleep
040916 - for 8 hours, reported on 090403 0300. ref SDS 53 UV3Y
040918 -  ..
040919 - Earlier in the week, perhaps on Tuesday or Wednesday, Millie began
040920 - having elevated temperature that reached 99.7 in the early evening
040921 - about 1900, and usually subsided to normal by midnight.  In these
040922 - cases, she initially took Vidadin, and then Tylenol.
040924 -  ..
040925 - Late at night beginning about 2300, Millie suffered continual cough
040926 - and shortness of breath until about 0400 the next day on 090403.  In
040927 - the morning, Millie notified the medical team about this change in
040928 - condition, reported 090403 1107. ref SDS 53 XZ6I
040930 -  ..
040931 - Doctor Hsu suggested visiting with the primary care physician about
040932 - investigating for pneumonia, and proposed immediate lab, reported on
040933 - 090403 1324. ref SDS 54 Z66M  Doctor Rugo also responded that Millie
040934 - should check with the primary care physician at Kaiser about symptoms
040935 - that occurred the night of 090402 and 090403, as reported on 090403
040936 - 1744. ref SDS 55 3G3N
040938 -  ..
040939 - Millie notified the primary care physician on 090403 1954, ref SDS 56
040940 - NW4N; and, she sent a 2nd letter about 20 minutes later on 090403 2012
040941 - explaining symptoms have subsided, so examination may not be needed.
040942 - ref SDS 57 ZG7H
040944 -  ..
040945 - Yesterday on 090406, Millie received a letter from Doctor Johnson
040946 - asking Millie to call Kaiser to schedule a meeting. ref SDS 58 M19I
040948 -  ..
040949 - Millie sent a letter to the medical team again reporting improved
040950 - conditions, and asked the doctor to call if a meeting is needed, and
040951 - whether a telephone consultation would be adequate? ref SDS 59 OC5F
040953 -  ..
040954 - Kaiser has not responded.
040956 -  ..
040957 - Called this morning and left a message for Arlette to ask Doctor
040958 - Johnson to check his email about Millie meeting for examination in
040959 - Millie's letter yesterday on 090406, ref SDS 59 RE7R, and about
040960 - referral arrangements for doing Millie's labs at UCSF to implement
040961 - planning during call with Pam in Outside Referrals on 090401 1214,
040962 - ref SDS 51 RG5K, and later reported to the medical team also on 090401
040963 - 1520. ref SDS 52 WC8T
040964 -
040965 -            [On 090409 1537 Doctor Johnson filed amended authorization
040966 -            for Millie's treatment with radiation and hyperthermia to
040967 -            include doing lab work at UCSF in order to save lives, time
040968 -            and money. ref SDS 62 6O6N
040969 -
040970 -
040972 -  ..
0410 -
0411 -
0412 - 1637
0413 -
041301 - Arlette called back...
041302 -
041303 - Doctor Johnson is off-site today.  Arlette sent him an email message
041304 - to call Millie about pending issues, per above. ref SDS 0 IF54
041305 -
041306 -            [On 090409 1537 Doctor Johnson filed amended authorization
041307 -            for Millie's treatment with radiation and hyperthermia to
041308 -            include doing lab work at UCSF in order to save lives, time
041309 -            and money. ref SDS 62 6O6N
041311 -  ..
041312 - Explained problem calling the Oncology Chemotherapy Infusion Clinic to
041313 - change the time of the blood draw on 090413 because Loretta changed
041314 - the time of the CT test on Monday from 1520 to 1500.  This requires
041315 - changing the time of the blood draw from 1500 to 1430 or 1415 so
041316 - there is enough time to walk the approximate .25 miles from the
041317 - Oncology Department to the CT Department.
041319 -  ..
041320 - Arlette asked why the CT Department changed the doctor's order for
041321 - the CT test on 090413 from 1520 to 1500?
041323 -  ..
041324 - Explained the change was made this afternoon for convenience of
041325 - Interventional Radiology Services (IS) to avoid overtime expense
041326 - supporting injection of contrast medium for Millie's CT tests with
041327 - Power Port technology,  Under Kaiser's interpretation of regulatory
041328 - requirements, they need a nurse from IS to observe connecting the
041329 - equipment, which takes about 10 seconds.
041330 -
041331 -        [...in another record today on 090407 1442 telecon with Loretta
041332 -        in the CT Department changed the time of the CT test on 090413
041333 -        from 1520 to 1500 in order to avoid overtime expense for nurse
041334 -        from Interventional Radiology Services (IS). ref SDS 60 L76N
041336 -         ..
041337 -        [On 090408 1113 Millie letter to medical team reported changing
041338 -        time of CT test on 090413 1520 to 1500, and need to change
041339 -        blood draw from 1500 to 1430. ref SDS 61 QW5Y
041341 -  ..
041342 - Called and left a message on the answering machine for the Oncology
041343 - Chemotherapy Infusion Clinic to change the time of the blood draw,
041344 - and then called a few mintues ago to verify the Chemotherapy Infusion
041345 - Clinic got the message and changed the schedule, or if there is a
041346 - problem that requires further coordination with the CT Department in
041347 - order to have the port accessed in time for the test on 090413.
041348 -
041349 -        [...in another record today on 090407 1442 called and left
041350 -        message for Oncology Chemotherapy Infusion Clinic to change the
041351 -        time of the blood draw on 090413 from 1500 to 1430 or 1415, so
041352 -        that Millie will have the port accessed in time for the CT test
041353 -        at 1500. ref SDS 60 W43J
041355 -         ..
041356 -        [...in another record today on 090407 1442 called back at 1622
041357 -        to verify the Oncology Chemotherapy Infusion Clinic changed the
041358 -        time for the blood draw; got message that the clinic is not
041359 -        accepting calls. ref SDS 60 FP7M
041361 -         ..
041362 -        [On 090409 1537 called Arlette; she coordinated with Bella in
041363 -        the Chemotherapy Infusion Clinic to change Millie's lab from
041364 -        090413 1500 to 090413 1330 which allows enough time to process
041365 -        results for creatinine needed for Millie's CT test at 1500.
041366 -        ref SDS 62 E54L
041368 -  ..
041369 - Arlette said the Chemotherapy Infusion Clinic message system refused
041370 - her attempt to transfer the call from the Oncology Department front
041371 - desk because the answering system is programmed to stop accepting
041372 - messages at 1600, rather than 1700 when the Oncology Department stops
041373 - accepting calls.  She will talk to the Infusion Clinic about giving a
041374 - message that explains the system is "Closed until tomorrow," rather
041375 - than simply say "The system is not accepting more calls."
041377 -  ..
041378 - Arlette can also ask the Chemotherapy Infusion Clinic to program their
041379 - customer answering system to accept calls after hours in order to
041380 - prevent emotional trauma from customers who are nervous about getting
041381 - essential care scheduled, as today.
041382 -
041383 -
041384 -
041385 -
041386 -
041387 -
041388 -
041389 -
0414 -